31 Mar Clinical course and risk factors for mortality of adult inpatients with COVID-19
With the global spread of COVID-19, it has never been more important than for information to be gathered and shared between health professionals in understanding, managing and treating the disease.
It is natural to look into the experience of China, where the epidemic began, with a wealth of clinical case studies and research emerging.
A retrospective cohort study was published on 11th March in The Lancet, investigating clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China:
Background
Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described.
The clinical spectrum of SARS-CoV-2 infection appears to be wide, encompassing asymptomatic infection, mild upper respiratory tract illness, and severe viral pneumonia with respiratory failure and even death, with many patients being hospitalised with pneumonia
Method
In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death.
Findings
191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p
Interpretation
The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 µg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future.
Reference: Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Fei Zhou, MD, Ting Yu, MD, Ronghui Du, MD, Guohui Fan, MS, Ying Liu, MD, Zhibo Liu, MD et al. Published: March 11, 2020 DOI:https://doi.org/10.1016/S0140-6736(20)30566-3